Provider Demographics
NPI:1417682832
Name:JESSOP, JAYCIE TAYLOR (LMT, CMLDT)
Entity Type:Individual
Prefix:
First Name:JAYCIE
Middle Name:TAYLOR
Last Name:JESSOP
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N HILL RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7249
Mailing Address - Country:US
Mailing Address - Phone:406-309-5553
Mailing Address - Fax:
Practice Address - Street 1:77 3RD AVENUE WEST N # WN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4049
Practice Address - Country:US
Practice Address - Phone:406-752-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-20302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist